心脏超声斑点成像联合microRNA-16-5p、microRNA-206诊断非ST段抬高型急性心肌梗死的价值及与疾病严重程度的相关性

Diagnostic value of cardiac ultrasound speckle imaging combined with microRNA-16-5p and microRNA-206 in non-ST elevation myocardial infarction and its correlation with disease severity

摘要:

目的 探讨心脏超声斑点成像技术联合microRNA-16-5p（miR-16-5p）、microRNA-206（miR-206）诊断非ST段抬高型急性心肌梗死（NSTEMI）的价值及与疾病严重程度的相关性。方法 选取2020年1月—2023年12月延安大学咸阳医院收治的102例NSTEMI患者为研究对象，根据全球急性冠状动脉事件登记风险评分体系将患者分为低风险组（55例）、中风险组（32例）及高风险组（15例）。测定并比较3组心脏超声斑点成像参数、血清miR-16-5p和miR-206水平，并采用Spearman法分析其与疾病严重程度的相关性。绘制受试者工作特征（ROC）曲线评价心脏超声斑点成像参数联合miR-16-5p和miR-206在疾病严重程度评估中的诊断效能。结果 中风险组和高风险组的整体长轴收缩期峰值应变（GLS）、整体圆周收缩期峰值应变（GCS）、整体径向收缩期峰值应变（GRS）、整体面积收缩期峰值应变（GAS）、GAS变化率（GAS rate）及三维左心室整体应变（3D-Strain）参数比较，差异均有统计学意义（P <0.05）。中风险组和高风险组的GLS、GCS、GAS、GAS rate参数的绝对值均低于低风险组，GRS和3D-Strain参数低于低风险组（P <0.05）；高风险组的GLS、GCS、GAS、GAS rate参数的绝对值低于中风险组，GRS和3D-Strain参数低于低风险组（P <0.05）。中风险组和高风险组血清miR-16-5p mRNA相对表达量均高于低风险组（P <0.05），高风险组血清miR-16-5p mRNA相对表达量高于中风险组（P <0.05）；中风险组和高风险组血清miR-206 mRNA相对表达量均低于低风险组（P <0.05），高风险组血清miR-206 mRNA相对表达量低于中风险组（P <0.05）。Spearman相关性分析结果显示，疾病严重程度与miR-16-5p、GLS、GAS、GCS、GAS rate均呈正相关（r_s=0.688、0.842、0.506、0.801和0.227，P =0.000、0.000、0.000、0.000和0.021），疾病严重程度与miR-206、GRS、3D-Strain均呈负相关（r_s=-0.615、-0.815和-0.860，均P =0.000）。ROC曲线分析结果显示，心脏超声斑点成像参数联合miR-16-5p和miR-206在诊断NSTEMI患者疾病严重程度方面具有较好的准确性，曲线下面积为0.971（95% CI：0.927，1.000），敏感性为93.3%（95% CI：0.807，1.000）；特异性为96.9%（95% CI：0.908，1.000）。结论 心脏超声斑点成像联合miR-16-5p和miR-206可作为评估NSTEMI患者疾病严重程度的有效诊断生物标志物，为临床提供新的诊断工具。

关键词:非ST段抬高型急性心肌梗死;心脏超声斑点成像;microRNA-16-5p;microRNA-206;诊断

Abstract:

Objective To explore the diagnostic value of cardiac ultrasound speckle imaging combined with microRNA-16-5p (miR-16-5p) and microRNA-206 (miR-206) in non-ST elevation myocardial infarction (NSTEMI) and its correlation with disease severity.Methods A total of 102 NSTEMI patients treated at Shaanxi Xianyang Hospital from January 2020 to December 2023 were selected as study subjects. Patients were classified into low-risk (55 cases), medium-risk (32 cases), and high-risk groups (15 cases) based on the Global Registry of Acute Coronary Events risk scoring system. Parameters of cardiac ultrasound speckle imaging, serum levels of miR-16-5p and miR-206 were measured and compared among the three groups. The Spearman correlation method was employed to analyze their relationship with disease severity. Receiver Operating Characteristic (ROC) curves were constructed to evaluate the diagnostic efficacy of cardiac ultrasound parameters combined with miR-16-5p and miR-206 in assessing disease severity.Results The global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), global area strain (GAS), GAS rate, and 3D-Strain were all found to be lower in the medium and high-risk groups compared to the low-risk group (P < 0.05). Additionally, the high-risk group showed lower values in these parameters compared to the medium-risk group (P < 0.05). Levels of miR-16-5p were higher in the medium and high-risk groups than in the low-risk group (P < 0.05), with the high-risk group exhibiting higher levels than the medium-risk group (P < 0.05). Conversely, miR-206 levels were lower in the medium and high-risk groups compared to the low-risk group (P < 0.05), and the high-risk group had lower levels than the medium-risk group (P < 0.05). Spearman correlation analysis indicated a positive correlation between disease severity and miR-16-5p, GLS, GAS, GCS, and GAS rate (r_s = 0.688, 0.842, 0.506, 0.801, and 0.227; all P = 0.000 except for GAS rate P = 0.021), and a negative correlation with miR-206, GRS, and 3D-Strain (r_s = -0.615, -0.815, and -0.860; all P = 0.000). ROC curve analysis diagnosed that the combination of echocardiographic speckle tracking parameters with miR-16-5p and miR-206 offers good accuracy in predicting the severity of NSTEMI (Non-ST-Elevation Myocardial Infarction), with an area under the curve (AUC) of 0.971, a sensitivity of 93.3% (95% CI：0.807, 1.000), and a specificity of 96.9% (95% CI：0.908, 1.000).Conclusion Echocardiographic speckle-tracking imaging combined with miR-16-5p and miR-206 can serve as effective biomarkers for assessing disease severity and predicting prognosis in NSTEMI patients, providing new diagnostic tools for clinical practice.

Key words:non-ST-segment elevation myocardial infarction;echocardiographic speckle-tracking imaging;microRNA-16-5p;microRNA-206;diagnosis